This is a small scale pilot study to evaluate if core warming improves respiratory physiology of mechanically ventilated patients with COVID-19, allowing earlier weaning from ventilation, and greater overall survival. This prospective, randomized study will include 20 patients diagnosed with COVID-19, and undergoing mechanical ventilation for the treatment of respiratory failure. Patients will be randomized in a 1:1 fashion with 10 patients (Group A) randomized to undergo core warming, and the other 10 patients (Group B) serving as the control group who will not have the ensoETM device used. Patients randomized to Group A will have core warming initiated in the ICU or other clinical environment in which they are being treated after enrollment and provision of informed consent from appropriate surrogate or legally authorized representative.
Participants will be randomized in a 1:1 fashion to core warming with the study device
(ensoETM) or to standard of care (standard temperature management and treatment). The device
will be used as indicated (for warming). Patient temperature measurement will be collected
for both the core warming and standard of care arms during the study period (72 hours).
Core warming will be performed using standard technique per instructions for use for the
esophageal heat transfer device. The esophageal heat transfer device will be set to 42°C
temperature after initial placement, and maintained at 42°C for the duration of treatment. It
is expected that patient temperature will increase from baseline by 1°C to 2°C, but due to
ongoing heat loss from the patient, the expected maximum patient temperature is below 39°C.
The time course of illness of COVID-19 is such that most patients no longer have fever by the
time of mechanical ventilation. If patient temperature increases above this range and reaches
39.8°C, the device will be set to an operating temperature of 40°C, thereby preventing any
further increase in patient temperature (ambient heat loss precludes patient from reaching
device operating temperature).
Control group patients will be managed as per standard of care currently utilized in the ICU,
which will include the use of other methods of temperature management as warranted. This
would include warming with a forced air blanket only in hypothermic patients (core
temperature < 36°C) or antipyretic therapy for febrile patients, as requested by the treating
physician. Episodes of hypothermia are infrequent and transient in this population, and the
current standard of care generally utilizes a permissive approach to fever (allowing patients
to remain mildly febrile) which will continue in the control group without modification (no
intentional elevation of temperature will be provided in the control group).
Follow up data will be collected at 1 month following enrollment.
Device: ensoETM device
Core warming will be performed using standard technique per instructions for use for the esophageal heat transfer device. The esophageal heat transfer device will be set to 42°C temperature after initial placement, and maintained at 42°C for the duration of treatment. It is expected that patient temperature will increase from baseline by 1°C to 2°C, but due to ongoing heat loss from the patient, the expected maximum patient temperature is below 39°C. The time course of illness of COVID-19 is such that most patients no longer have fever by the time of mechanical ventilation.[41] If patient temperature increases above this range and reaches 39.8°C, the device will be set to an operating temperature of 40°C, thereby preventing any further increase in patient temperature (ambient heat loss precludes patient from reaching device operating temperature).
Inclusion Criteria:
1. Patients above the age of 18 years old.
2. Patients with a diagnosis of COVID-19 on mechanical ventilation.
3. Patient maximum baseline temperature (within previous 12 hours) < 38.3°C.
4. Patients must have a surrogate or legally authorized representative able to understand
and critically review the informed consent form.
Exclusion Criteria:
1. Patients without surrogate or legally authorized representative able to provide
informed consent.
2. Patients with contraindication to core warming using an esophageal core warming
device.
3. Patients known to be pregnant.
4. Patients with <40 kg of body mass.
5. Patients with DNR status.
6. Patients with acute stroke, post-cardiac arrest, or multiple sclerosis.
7. Patients with history of esophageal disease
8. Patients with a baseline epinephrine dose greater than 0.6 mcg/kg/min
9. Patients with atrial fibrillation, atrial flutter, or other multifocal atrial
tachycardia with a heart rate greater than 110 beats per minute.
10. Patients on 0.2 mcg/kg/min or more of norepinephrine
Barnes-Jewish Hospital
Saint Louis, Missouri, United States
Anne Drewry, MD, Principal Investigator
Washington Univeristy School of Medicine